Preview

Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems such as heart disease, diabetes and high blood pressure.

Classification

BMI Kg/m2

Principal cut off points

Additional cut off points

Underweight

<18.50

<18.50

Severe thinness

<16.00

<16.00

Moderate thinness

16.00 - 16.99

16.00 - 16.99

Mild thinness

17.00 - 18.49

17.00 - 18.49

Normal range

18.50 - 24.99

18.50 - 22.99

23.00 - 24.99

Overweight

>=25.00

>=25.00

Pre-Obese

25.00 - 29.99

25.00 - 27.49

27.50 - 29.99

Obese

>=30.00

>=30.00

Obese class I

30.00 - 34-99

30.00 - 32.49

32.50 - 34.99

Obese class II

35.00 - 39.99

35.00 - 37.49

37.50 - 39.99

Obese class III

>=40.00

>=40.0

Table 1: The World Health Organization International Classification of adult underweight, overweight and obesity according to BMI

Being extremely obese means you are especially likely to have health problems related to your weight.

For most people, BMI is a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category even though they don't have excess body fat.

Being a little overweight may not cause many noticeable problems. However, once you are carrying a few extra kilograms (or pounds), you may develop symptoms that affect your daily life.

Health problems

Obesity can cause day-to-day health problems such as:

Breathlessness

Increased sweating

Snoring

Difficulty sleeping

Inability to cope with sudden physical activity

Feeling very tired every day

Back and joint pains.

Obesity can also cause changes you may not notice, but that can seriously harm your health, such as high blood pressure (hypertension) and high cholesterol levels (fatty deposits blocking your arteries). Both conditions significantly increase your risk of developing a cardiovascular disease, such as:

Coronary heart disease, which may lead to a heart attack

Stroke, which can cause significant disability and can be fatal.

Another long-term problem that can affect obese people is type 2 diabetes. It is estimated that just under half of all cases of diabetes are linked to obesity. In addition to the day-to-day health problems, many people may also experience psychological problems such as:

Low self-esteem

Low confidence levels

Feeling isolated in society.

These can affect relationships with family members and friends and may lead to depression.

Obesity is a complex disease for which no single cause or cure exists. You gain weight when you take in more calories than you burn off. But obesity is influenced by many other things, including:

Your habits: Eating unhealthy foods and overeating are easy in our culture today. Many things influence eating behavior, including emotions, habits, and the availability of food.

Your lifestyle: Modern conveniences:such as elevators, cars, and the remote control for the television:cut activity out of our lives.

Your genes: If one of your parents is obese, you are more likely to be obese than someone who has parents of healthy weight.

Your friends and family: If they eat a lot of snack foods high in saturated fat, eat at irregular times, and skip meals, you probably will too. And if they are not physically active, you may not be either.

Lack of sleep: Too little sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.

Other things influence your weight and whether you are physically active, including:

Low self-esteem: Being overweight or obese may lower your self-esteem and lead to eating as a way to comfort yourself. Repeated failure at dieting also can affect your self-esteem and make it even harder to lose weight.

Emotional concerns: Emotional stress, anxiety, or illnesses such as depression or chronic pain can lead to overeating.

Trauma: Distressing events:such as childhood sexual, physical, or emotional abuse; loss of a parent during childhood; or marital or family problems:can contribute to overeating.

Alcohol: Alcohol (beer, wine, and mixed drinks) is very high in calories.

Medicines or medical conditions: Some medical conditions and medicines may also cause weight gain. Examples include hypothyroidism or taking certain antidepressants or corticosteroids.

Pregnancy: During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.

See your doctor if you are obese and you wish to lose weight to talk about things like:

What type of diet is right for you

How much and what type of exercise is appropriate for you.

Whether you need further testing or treatments for obesity-related conditions

Whether you need treatment for an underlying cause of obesity such as polycystic ovary syndrome.

Your doctor may refer you to other professionals and services for advice such as an exercise physiologist, a physiotherapist or a dietitian.

Exercise: If you're overweight or obese, losing weight can bring you a range of important health benefits.

Diet: Most people will need to reduce their daily kilojoule intake in order to lose weight.

Medicines: There are several prescription and non-prescription medicines available for weight loss.

Surgery

Obesity surgery or bariatric surgery can help some people to lose weight by changing the way the body digests and absorbs food.

To decide whether or not someone qualifies for obesity surgery, a doctor will take into account such things as having a very high body mass index (BMI), being unable to lose weight by other means, and being physically unable to perform daily tasks. To find out more about surgery for obesity talk to your doctor.

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DIAGNOSIS OF OBESITY

Body mass index (BMI): is often used to assess if you are overweight or not.

How to measure your BMI:

To measure your BMI you will need to know your height in meter and weight in kilograms. It is easiest to use a calculator to calculate your BMI. For most adults:

If possible give a link to the BMI calculator.

BMI between 18.5 and 24.9 is considered a healthy weight

BMI between 25 and 29.9 is considered overweight

BMI over 30 is considered obese.

The BMI calculation cannot take into account very muscular figures. Muscle can add extra weight, and this may give you an overweight or obese BMI when you are not an unhealthy weight. For example, a heavyweight boxer would be classed as obese using the BMI, when he is in fact a healthy weight for him.

However, for most people, BMI remains an accurate method of assessing weight.Children and young people should not use BMI to calculate if they are a healthy weight, as their bodies are still developing. Instead, children and young people should visit their doctor, who will be able to tell them if they are overweight or obese for their height and sex.

Waist circumference

Another useful method to assess your weight is to measure your waist circumference. Men whose waist measurement is 94 cm or more and women whose waist measurement is 80 cm or more are more likely to develop obesity-related health problems, such as type 2 diabetes, heart disease and some types of cancer.

Talk to your doctor about:

Any underlying causes your might have for your obesity - for example, if you are on certain medication or have a medical condition that causes weight gain

Your lifestyle - particularly your diet and how much physical activity you do, and also whether you smoke, and how much alcohol you drink

How you feel about being overweight - for example, if you are feeling depressed about it

How motivated you are to lose weight

Your family history of obesity and other health conditions, such as diabetes (a condition where there is too much glucose (sugar) in the blood).

Further tests

As well as calculating your BMI, your doctor may also perform tests to determine if you are at increased risk of health complications because of your obesity. These could include:

Besides the obvious challenges of being overweight or obese in our world, when it comes to exercise, plus-sized people have even more obstacles getting in their way. Even a Little Exercise Fights Obesity

Survey Shows 1 to 2 Days a Week of Exercise Has Benefits for Physical and Mental Health.

Do errands on foot, if possible. If you need to drive, park farther away and walk to your destination.

Go to a spa, gym, or exercise class. Water aerobics classes are especially good if you have back, knee, or joint problems.

Do some form of strength training using gym equipment or your own body weight? In addition to making your muscles stronger and able to work longer without getting tired, strength training helps you burn more energy when you are at rest. Muscle mass burns more calories than fat so as your muscle increases so does your ability to burn calories.

Walking is a great way for almost everyone to increase the amount of time they exercise. Using a pedometer can be fun and motivating. A pedometer is a device that attaches to your clothing and tracks how many steps you take in a day. A good goal is to work up to 10,000 steps a day (5 miles). If your provider agrees, try increasing your steps each week by 500 a day until you reach 10,000 steps a day.

Swimming is a recommended exercise for obese people, and while this is wonderful if you have a pool in your backyard, what if you don't? Walking around in a bathing suit causes instant panic for plenty of people, but even more so if you're overweight or obese.

YOGA FOR OBESITY:

One simple yoga asana that anyone can do is a Sun Salutation. Sun Salutations are a complete practice by themselves. They raise your heart rate, improve muscle strength and definition, and quiet the mind.

Here is how to perform a basic Sun Salutation(Surya-Namaskara):

1) Start in a standing position with your heels together, arms at your side. Deepen your inhales and exhales as you breathe slowly in and out of your nose.

2) As you inhale, raise your arms up over your head bringing your palms together.

3) As you exhale, open your arms to your sides and fold forward, bending your knees if you need to. Let your arms come down towards your legs with your fingertips or palms touching or trying to touch the floor.

4) As you inhale, lift your heart and head up, halfway and look out beyond the tip of your nose.

5) On your next exhale, press your palms into the floor and step your right foot back and then your left foot back and lower yourself down onto your belly or keep your belly lifted off the floor. Your elbows should be bent, palms flat on the floor adjacent to your breast bone.

6) As you inhale, slide on to the tops of your feet, pulling your lower belly through. Gaze up towards the ceiling and allow your shoulders to drop away from your ears.

7) As you exhale, curl your toes under you, raise your hips and extend back into downward dog as your heels reach towards the floor. Resist the urge to bring your feet flat to the floor by walking your hands towards your feet or vice versa. Instead, keep your legs where they are and breathe here for at least 5 complete breaths.

8) At the end of your exhale, walk your feet to your hands and lift your head and heart up halfway with your fingertips still on the ground.

9) As you exhale, fold in towards your legs.

10) As you inhale, lift your torso up, taking your arms out to your sides and finishing with them over your head, palms together.

11) As you exhale, lower your arms to your side finishing just like how you began.

Your effort to overcome obesity is more likely to be successful if you follow strategies at home in addition to your formal treatment plan. These can include:

Learning about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it. You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist.

Setting realistic goals. When you have to lose a significant amount of weight, you may set goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure. Set daily or weekly goals for exercise and weight loss. Make small changes in your diet instead of attempting drastic changes that you're not likely to stick with for the long haul.

Sticking to your treatment plan. Changing a lifestyle you may have lived with for many years can be difficult. Be honest with your doctor, therapist or other health care providers if you find your activity or eating goals slipping. You can work together to come up with new ideas or new approaches.

Enlisting support. Get your family and friends on board with your weight-loss goals. Surround yourself with people who will support you and help you, not sabotage your efforts. Make sure they understand how important weight loss is to your health. You might also want to join a weight-loss support group.

Identifying and avoiding food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry - not simply when the clock says it's time to eat.

Keeping a record. Keep a food and activity log. This record can help you remain accountable for your eating and exercise habits. You can discover behavior that may be holding you back and, conversely, what works well for you. You can also use your log to track other important health parameters such as blood pressure and cholesterol levels and overall fitness.

Taking your medications as directed. If you take weight-loss medications or medications to treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as prescribed. If you have a problem sticking with your medication regimen or have unpleasant side effects, talk to your doctor.

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Lifestyle

Positive Changes

Weight Management

Move those muscles and Be Active.

Research has shown that leaner and more active people are less likely to get diabetes. To find out your ideal weight and Body Mass Index (BMI) go to this link. Record your weight every day.

Blood Glucose management

Hypoglycemia (wherein the blood glucose levels drop to dangerous levels) can result in catastrophic complications. To prevent this always keep a something to eat such as chocolate or sugar candy; also it is wise to let your near and dear ones and colleagues to know that you are diabetic so that they can help you in such episodes of hypoglycaemia. Please follow the link for more information on Hypoglycemia.

Keep your blood sugar in constant check by maintaining a balanced diet and a prudent lifestyle. Keep a track of your blood sugar at home by monitoring it with glucometer at different intervals of the day.

Alcohol

Abstinence is the best policy.

Alcohol is high in calories, can increase blood pressure and blood sugar. If you drink, ask your doctor first.

Medication

Some of the medicines used for diabetes can have interactions with various medicines. Check with your doctor when you are taking any new medicines.

Tobacco and Smoking

Quit!

Research suggests that tobacco use and smoking can make diabetes worse and may lead to other eye or kidney failures. Need help quitting, call - the National Tobacco Cessation Quit Line, 1800-22-77-87

To know more about the health benefits of quitting, go to

Stress Management

High stress levels may increase blood glucose levels. Incorporate a daily routine to relax and rejuvenate try to listen to soothing music, chant, read a book or meditate.

Sleep

A sound night sleep is suggested to improve insulin use by the body. Exercise can help inducing sleep.

Caffeine

Reduce the intake of tea, coffee, colas and chocolate especially later in the day. Lowered caffeine intake is known to induce a better sleep during the night which in turn improves insulin use by the body.

Blood Pressure management

Maintaining a normal blood pressure of lower than 120/80 is important to lower the risk of further complications. Exercise can help to maintaining normal blood pressure

Schedule for consultations/Diagnostic tests:

Seek medical intervention if your self efforts do not yield desired results of weight and health.

The doctor can help diagnose underlying medical causes for obesity and refer you to specialists or therapists.

It is important to eat the right kind of food for a healthy mind and body. Diabetes Mellitus (Type 2) is a chronic metabolic disease where the body doesn't take up insulin properly which results in high blood sugar. It is recommended that people with diabetes should avoid fasting. Try to incorporate 6-7 small meals/snacks during the day.

Generally, all food items can be classified into six major groups (3) as shown in the Healthy Food Pyramid.(4)

Immediate Diet Plan

Do's

1.Include lots of fresh, seasonal, local and if possible organic Fruits and Vegetables.

5.Slash down any intake of carbonated, caffeinated or alcoholic beverages.

6.Curb your Salt intake, as sodium in the salt has to tendency to retain water in the body which can increase blood pressure and add other complications. Do not add salt while cooking and restrict consumption of packaged food. (5)

Below is a sample Diet Plan for a patient who is Obese. Make sure to check the correct portion/serving sizes for each food item by going to these links.

To meet your nutrient needs, select 8 servings of grains, 3 servings of legumes, at least 4 servings of vegetables, and 3 servings of fruit daily. It's important to vary the foods you choose within the food groups, because not only is variety the spice of life it helps you to cover all your nutritional bases. The food guide chart below will provide you with about 1500 calories. At the end of this guide, you will find ways to adjust this level of calories to meet your own energy requirements.

You should get 8 servings a day. A serving is cup cooked grain, like oatmeal or pasta, 1 oz. of dry cereal (usually cup to 1 cup), one slice of bread, or half a pita bread or tortilla. Most bagels are actually four Servings. Eight servings may sound like a lot, but 1 cup of

oatmeal for breakfast, a sandwich with two slices of bread for lunch, and a bowl of pasta made with 11/2 cups of spaghetti with a slice of French bread meets your 8-serving goal.
Check the servings off each day:

Legumes
(A serving equals about 100 kcal)
Have at least 1 cup of beans every day.

You should have 3 servings from the legume group each day. A serving is a half-cup of cooked beans, cup low-fat bean spread, 1 cup low-fat soymilk, or 1 oz. of veggie meat substitute. Check the servings off each day:

Vegetables
(A serving equals 35-50 kcal)
At least one serving should be a raw vegetable like salad or carrot sticks and one should be a dark leafy green vegetable like kale or broccoli.

You should aim for at least 4 servings of vegetables each day. This means cup cooked or 1 cup raw. As long as the vegetable isn't topped with a fatty dressing or sauce, you can eat as many servings as you want from this group. At least 1 of your vegetable servings should be calcium-rich, dark leafy greens, such as broccoli, kale, or

collards. Check the servings off each day:

Fruit
(A serving equals 80 kcal)

Limit fruit juices and eat whole pieces of fruit instead.

Aim for 3 servings of fruit each day. A serving is cup chopped or one small piece of fruit. Aim for low-calorie, high-nutrition fruits like strawberries, kiwis, mangoes, blueberries, peaches, plums, oranges, grapefruit, and raspberries.Check the servings off each day:

Sweets
(optional)

One sweet serving has no more than 1 gram of fat and equals 100 kcal.

You should have no more than 1 sweets serving per day. Your sweets should be fat free. Try fruit if you are craving sweets. Other low-fat ideas include a bowl of sweetened whole grain cereal with low-fat soymilk, a soymilk/fruit smoothie, or saut'ed bananas or apples (in water and a bit of maple syrup) with a little cinnamon.

DIET PLAN FOR NORTH-INDIAN POPULATION:

MEAL

FOOD TYPES

NORTH (NEW DELHI)

Early morning

1/2 serving of milk products

1/2 serving of cereals

1 cup of tea or 1/2 a cup of buttermilk

2 Marie biscuits or 1/2 of a methi paratha (30g)

Breakfast

1/2 serving of milk products

2 servings of cereals

1 serving of meat/poultry/milk products

1 serving of fruit

1 serving of fat

1 cup of milk/curd or 25g of cottage cheese

2 chapatis or 2 slices of bread or 6 tbsp of cornflakes or 1/2 a cup of porridge

2 egg whites of 30g of cottage cheese (paneer)

1 medium-sized apple/orange/guava/pear or a medium slice of papaya or 10 grapes